ADHD is a Real Disorder, Being Lazy and Self-Entitled is Not

My graduate school had its own clinic that provided free services to students and very low-fee services to the members of the community. Often undergraduates would come in seeking an evaluation for Attention Deficit-Hyperactivity Disorder (ADHD). Most people are familiar with the basics of the term and its symptoms but you can read a very good summary of it here. Students usually came in when they were struggling with course work and wanted certification they had a veritable condition. With documentation students were often given more time on tests, tutoring or other academic benefits. Often these concerns were perfectly legitimate and the students really suffered from ADHD, making it extremely difficult for them to succeed in the academic arena. Pinning down the problem for them so they could get help, both academically and psychologically, was not only rewarding but it also made you feel like a real doctor. On other occasions something was wrong with the student but he didn’t have ADHD; rather something such as anxiety or depression was the problem. Here the student was offered psychotherapy and/or medication to treat the issue.

A third possibility occurred when the students’ complaints were a complete scam and the kid was just too damn lazy to pick up a book or go to her 8 AM Physics class. This happened a lot in the late 90’s when Adult ADHD was becoming the “in diagnosis” and some students tried to exploit that by seeking out unnecessary special treatment or to get their hands on some ADHD-meds for recreational purposes:

Student: I just can’t focus during my morning classes and my mom and I are pretty sure I have ADHD.

Rob: What time do you usually go to sleep at night?

Student: Around 5.

Rob: 5 AM? So you’re getting about 2 hours of sleep per night. Why is that?

Student: I’m usually drunk and high until then.

Rob: So you’re basically just hung over and tired in the mornings.

Student: Yes.

Rob: That’s not ADHD.

Student: It isn’t? Are you sure?

Rob: Quite.

Student: Oh. Can I still get some Ritalin?

Rob: What for?

Student: To get high.

Scenarios like these particularly annoying when a student’s mother would follow up and call me at the clinic and offer a monetary sum (i.e., bribe) to “get Dakota the help she needs.”[1] If you’re not a morning person, don’t register for those classes! I couldn’t pass Physics if I tried but I’ll be damned if I’m stupid enough to take a class that early. ‘Wanting to Sleep In’ is not a psychological disorder. I thought a profile was developing where the most likely fakers (also known as ‘malingerers’) were very wealthy and accustomed to using money as a way to solve problems but my training director said I was simply jealous that I was only middle class. Someday I’m going to revisit my theory.

ADHD is one of the more controversial diagnoses in mental health due to a lack of any scientific method of testing for it. Researchers and clinicians have attempted to develop objective tests but none have proven to be valid or reliable. Professional decorum prohibits me from going into detail about how a clinician fleshes out the real sufferers from the poseurs, but make no mistake: if you come to my practice, showing no symptoms, looking for paperwork that says you don’t have to take the SAT’s and should still be accepted to Yale, you will know my wrath. The form of this wrath is yet to be determined but could include a bill with an angry face on it.

[1]There are doctors who will trade diagnosis for payment. This is especially easy to do with ADHD because the symptoms are so broad and vague, thus making it easy to argue a case for it. I don’t actually know any of these doctors personally, but colleagues have shared the fact that they know “hired guns” for these types of situations. Ritalin is certainly not cocaine, so I’m not claiming these doctors are ruining people’s lives, but they certainly aren’t challenging the argument that our society is over-diagnosed and overmedicated.

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31 Responses to “ADHD is a Real Disorder, Being Lazy and Self-Entitled is Not”

Semi-recreational use of Adderall happens sometimes in school now, I’ve heard it more in the law school or in engineering than anything else. Not so much to get high with, but someone will borrow another kid’s ADHD medicine and have a very productive, focused, and distraction-free afternoon of homework. Some kids consider it kind of cheating, like using steroids in the olympics, because it lets you focus your time better and not get distracted.
I just think they need to get rid of their computers and live in a 2-person apartment. If you don’t have anything else to do, homework gets done.

I liked this post… ADHD feels like such a scam on most fronts.
I was “diagnosed” with ADHD when I was a kid and spent most of my childhood on Ritalin. I had too much energy and never focused on my schoolwork.
Lo and behold, as soon as I was old enough to start going to the gym regularly and as soon as I found ways to interest myself in my work, my ADHD “mysteriously” disappeared.

I’m glad someone said it. I think people with ADHD are largely full of shite. As are the large number of prescribers doling out the meds. I worked in Mental Health for 18+ months. The number of people calling saying the want to be diagnosed with ADD/ADHD is absurd. Get off your duff, stop acting like the world owes you anything, and take responsibility for your actions. You fail tests? Study. You can’t focus? Turn off the tv, your cell phone, your laptop, your xbox, and learn to prioritize. Even better are the ones who already have the meds but say, oh I need a higher dose, but just give me more pills, not a different pill. Who then turn around and hock the extras all over college campuses nationwide. Fuck them, fuck ADD/ADHD, and fuck self-absorbed, self-important, resource sucking douchebags.
Dr Rob note: I don’t think I’d take it quite this far.

saying fuck ADD/ADHD is like treating the people who really do have it badly just because some people lie about it and use the meds in the wrong way. There are some people out there who actually do suffer from this problem and need the meds. It is a real problem.

Thank you so much for writing this! I was diagnosed with ADD at around 10 or 11 and my brother was diagnosed with Aspbergers at about that age. I think we were both misdiagnosed, which is especially ironic since my mother was studying for a masters in psychology. I eventually took myself off medication at 18. I spent the five years since trying to learn the social skills I didn’t develop because I was drugged during my middle and highschool years.

I often hear people say that ADHD is just a made-up diagnosis. However, I have known a few people who really had ADHD and I have seen their struggles to maintain their lives and make it through college getting good grades. It’s no easy task. I think all the people who try to get diagnosed ADHD give the whole thing a bad name and make it more difficult for the legitimate cases.

Yes, yes, yes. As someone with ADHD, this is pretty much exactly on point. I can’t tell you how frustrating it is when someone goes “god I’m so ADD today”. Well when you sleep 4-6 hours a night what do you expect?
I think in high school people actually believe they have it because of the poor sleeping habits high school usually breeds. In college you usually already know or you are just trying to score Adderall to take for tests/get high/sell.

Miss Ryan, you are not a very bright person and probably smell bad. I’m glad your 18 months in the field is enough to say that my 17 years of school was “self absorbred, self important, and resource sucking” The fact of the matter is I’ve been clinically tested and have an IQ of 140 but perform in school at an IQ level of 100 because of my various learning disabilities (dyslexia, dysgraphia, and ADD). I have been in Gifted/Talented and Special Education classes, I have read 400 page books in one day, and written 3 page papers in half an hour when on medication and considering I have a reading rate (words per minute) in the 13 percentile thats not bad. I’m just really glad you’re an open minded understanding person with considerably more experience in this matter than myself. Unfortunately you probably smell bad.

I used to vanish into my own head for blocks of time while in class, with a myriad of negative results. These range from coming into class on a test day without knowing there was a test, having been spaced out when it was announced, or not having information necessary to perform competently in class. Falling behind was the norm, and usually by November of a school year I had already been established, against my will, as a ‘slacker’ and a ‘problem student.’
Eventually I told my mom that I thought I had ADD, and wound up getting prescribed medication. I no longer take it, but just being able to see how my brain would function were I normal was the biggest step in learning to correct the ADD. The biggest problem from my learning disorder, one that still remains, is that my inability to achieve in the classroom despite all my efforts led to me ceasing to try, using apathy and contempt as a defense mechanism to shield me from the pain of my own failures. In short, I’ll be 21 within the year and I still haven’t overcome ADD and its consequences.
It is a real disorder, some people truly suffer from it, and we are not slackers or underachievers. We have a mental disorder and are proud of how hard we’ve had to work to overcome it.
(note: yes, there are a lot of douchebags who fake it for adderal. very true. but do you let oxycontin abusers paint an image of people who suffer injuries and need painkillers to function?)

I have no knowledge about this field, and I don’t mean to offend anyone, but if there is no physically detectable cause or atleast difference in people with ADHD and those without, then surely it is a personality trait rather than a medical condition? Can someone have more of an ADHD condition than someone else? I think as a society when we find people who extend to the extremes of what we consider to be normal and functional, we label it as a condition and medicate them towards normality. I don’t apply this to other learning disabilities like dyslexia as there is obviously a measurable difficulty in reading part of the brain, but measuring something like someone’s ability to focus seems similiar to me as measuring someone’s ability to be honest, or generous, or rational? (all of which, pushed to the extremes, I think, would have some mental disorder associated with them). Again, this is all just speculation, and am more than happy to be corrected.

Why are people who fake it for Adderall douchebags, exactly? If I make the well-informed decision that the benefits of use outweight the known and likely risks (this would be more the case for people trying to work more rather than recreational users, I imagine) then why shouldn’t I be allowed to purchase it out of pocket? We don’t make people lie about ‘Sleep Deficit Disorder’ to get an extra-caffeinated latte at Starbucks; nor do we prevent adults from buying alcohol even though its health risks are well-established. Stop making people lie to get the chemicals they want and they’ll stop pretending to have ADD.

What Nick said.
“Stop making people lie to get the chemicals they want and they’ll stop pretending to have ADD and / or synthesizing them out of household chemicals, resulting in unnecessary death, addiction and removal of civil liberties over “bad” people.”
Thought I’d add this, though.

Wow, hot topic today Dr. Rob!
I wanted to respond to Pete’s comment about whether ADD is just “a personality trait rather than a medical condition.” I think this question is a good one, and is something that I struggle with as well.
I think that the clinically correct answer is that like depression, there is a chemical imbalence and that just because you can’t physically see it doesn’t mean its not there. (Dr. Rob?) Dr. Rob Note: “It might not be a chemical imbalance per se, but many believe that the area of the brain that is responsible for attention and focus is not working at full speed. Hence the reason why stimulants have this paradoxical effect on hyperactive people. But yes, just because you can’t see it doesn’t mean it isn’t there.”
However, I think it is incredibly difficult to understand and accept that a problem such as AD(H)D, depression, etc., is caused by a chemical imbalance in the brain and is not just a “personality trait.”
And I am not talking as someone on the outside looking in…I have been diagnosed with depression and take anti-depressants, but still struggle with accepting that I am “sick” and not just “weak” or looking for a way to make life easier. In fact, that struggle lead me to take myself off the medication since I was sure I could “be happy” if I just exercised/ate right/used fish oil supplements/etc…it didn’t work!!

” think as a society when we find people who extend to the extremes of what we consider to be normal and functional, we label it as a condition and medicate them towards normality. ”
The problem is, people who truely have ADD/ADHD aren’t exactly “functional” the way a “normal” person is. I was never diagnosed with ADD when I was in school because I was in school at a time when ADD/ADHD was just being diagnosed. In fact, when 1 student in my school was put on Ritalin it was a big deal.
Anyway, saying that we medicate people with ADD?ADHD to toward “normality”, in my opinion, is the same as saying we medicate people with depression toward normality. Until you understand how ADD affects the lives of people who truely have it, you can’t possibly understand the difficulty functioning in daily life.
I have chosen not to be medicated but I often wonder how different I would feel if I was medicated. I wonder how much more smoothly my day would go if I was able to focus on one task at a time and get something done rather than getting 15 things half done. I wonder how much better I would have done in school if I could have concentrated and not been so distracted by everything and anything. When I was in school we didn’t have iPods and game consoles and 153 channels so it wasn’t just those sources of distraction.
Imagine laying in bed at night and trying to go to sleep while 15 people are in the room having random conversations. That’s what it was like for me, and still is to a certain extent. It’s taken years to train myself to “turn off” some of those sounds and be able to get to sleep. The same is true for having a conversation with someone. Imagine talking to someone and while you’re listening to them you’re also having 3 other conversations, in your head. Not in a crazy “I hear voices” kind of way but just not being able to keep your thought process going in one direction. Or, you’re sitting with someone and start a conversation somewhere in the middle because you’ve already had half the conversation in your head and it doesn’t occur to you that the other person isn’t “keeping up” with your thought process. For something really interesting, watch 2 people with ADD have a conversation.
I absolutely agree that ADD/ADHD is over diagnosed and over medicated. But, to imply that it’s not real becuase we can’t quantify it I think is doing a disservice to the people who truely need, and benefit, from the medication.

I often have teachers and schools pressuring me to diagnose a child ADHD while they may not fit the diagnosis. The school will get additional money from the state for each child that receives an IEP, which ADHD diagnoses qualify for. If i don’t give a ADHD diagnosis the first time, they send the child from school again to be “rediagnosed” with ADHD a week later. I admit, there are some kids that I will give a diagnosis to that do not fit the criteria, but for the well being of the child and some of the other problems that they are having at school; ADHD is the easiest way to get additional help, even if it isn’t the primary problem, and the stigma attached to it as opposed to other disorders is not as great.

I think many of your readers missed the point of article. It’s clear from your headline that you know ADHD is real. People who have ADHD for real don’t just get over it — even with medication. College is a very difficult time for all young people — it’s the first time you are truely responsible for keeping track of yourself. Many kids struggle with learning new self-management skills in this environment. I remember how hard it was for me to learn self-disclipline my freshman year, and I don’t have ADHD!
But for kids with ADHD, there are extra challenges, and college can be a time when they crash and burn. There are plenty of studies that show that without treatment, youth with ADHD at are much higher risk of drug abuse, arrest and other difficulties.
Medication is not the only way to be successful with ADHD. The Edge Foundation offers ADHD coaching to high school and college students with ADHD. A coach can help an otherwise organizationally-challenged and impulsive person, keep focused on their personal priorities.
I recently wrote an article about going to college with ADHD which may be of interest to some of your readers. I hope you’ll check it out and let me know what you think in the comments.http://www.edgefoundation.org/blog/2008/11/02/college-success-with-adhd-coaching/
Dr. Rob Note: I think what this program offers could be a good ancillary part of ADHD treatment, but other than a few anecdotal papers there is no solid research to support this or any other non-medicinal approach to ADHD. Megavitams, CBT, social skills training, etc. can all help but, like conditions such as Bipolar and Schizophrenia, ADHD sufferers get the best outcome with medication at the forefront.

I’m in college, and on suspicion I went to the doctor to talk about whether or not I had ADD. I’ve always had a lot of trouble following any sort of conversation in rooms where other conversations are going on, I also can’t do homework if there’s any noise. I’m not talking about not being able to watch TV and do work at the same time, I’m saying that no one can be talking in the room next to me, there can be no noise from the streets, and music (even wordless classical) is definitely out. Oh yeah, and Ochem classes? I would go to class and try as hard as possible to pay attention, half way through I’d realize I’d missed half the lecture, and my notes are piecemeal- then would have to go home and teach myself all of this from the book. So, yes, I was given Riddlin. My grades have shot up and the amount of time I spend on homework has decreased dramatically. I can converse while riding the subway, I don’t have to tell my boyfriend to sit quietly in the other room while I’m writing my papers. All I can say is that there is a profound silence in my mind that I have never experienced before.
Look, is it possible that I’m medicating a personality trait? I’d say that it’s probable, ADD people are those who fall on the far end of a spectrum of behaviors. However, this is true of other mental diseases such as Autism and Ausbergers, this is also true of OCD. Ultimately you need to ask the question, what is medication supposed to do for us? I feel that I can use this medication to achieve goals that I would not have otherwise been able to while taking 5 hours to write 4 page papers. I want to be a good scientist and a capable, intellectual person. I am completely capable of understanding the things that I’m studying, but I’m having trouble doing that studying in a reasonable amount of time. I have tried other ways of correcting this, but mere behavior modification has not worked all that well and is not always practical (living in a soundproof box does not really work). In this case, I think that it is reasonable for me to try medication.
Any thoughts?

Great post! While I’m not a therapist, I come from a family of them, and I’ve heard many of the same things about diagnosing and prescribing for ADHD– but this college student thing is just insane! How can a person honestly think they have ADHD because he/she can’t focus in class at 8 a.m. with a hangover. When I was in school we always figured, if you did the crime, you did the time. You sucked it up and handled the class– hangover and all– then stopped signing up for 8 a.m. classes after freshman year!

Following up to Dr. Rob’s comment that “ADHD sufferers get the best outcome with medication at the forefront.” Yes, the Edge Foundatin agrees with you that medication is helpful for many people with ADHD. We recommend ADHD coaching is being one part of a multi-modal intervention for ADHD includings medication, diet, excercise and therapy.
You may be also interested to know that the Edge Foundation is currently conducting a study at Wayne State University to provide data to back up our belief that coaching works.
Pills alone can’t teach skills. Coaching can. And it can help a person develop better habits than can minimize the impact ADHD has in his or her life.

“Pills can’t teach skills” does make a nice slogan.
I don’t know much about ADD, but I’ve struggled with Social Anxiety Disorder for most of my life. Guys like me go in to see a therapist and say “I just wish I knew how to act in social situations,” so the helpful shrinks try to teach us social skills.
The thing is, most of the time we do know how to act. The reason we lock up is because we’re afraid that we won’t know how to act.
I’m willing to bet it’s the same way with ADD. These kids know how to study, they just can’t do it!

I am a physician who also has ADHD. The debate of ADHD being a true disorder is becoming less and less important while the underlying cause is now being researched. Anyone with training in the nuero physiology of ADHD positive patients will identify multiple measurable changes in both the receptors (of many different functions especially inhibitory effectors) and the actual neuro transmission pathways. Many times trauma whether in the fetus or emotional invokes irreversible changes in various neuro synapse potentials that important in day to day tasks and focus.while I agree people are misdiagnosed for it instead of ptsd depression etc but I find it amazing that people assume that lazy-ness is the cause. Talk to people with obvious ADHD and all would prefer to not have it because forgetfullness of simple things like leaving car keys or cell phones. I understand your view and negative percieved tone of this piece but please read the most up to date on the disease and the future of medical imaging for help diagnosing the true disorders Instead of simply taking the limited psychology pre psychiatry referal that while important is easily manipulated.

I’ve done ADHD research, and it definitely is real…though most people who think they have it, do not. Parents seem to want to lean on a Dx to excuse their crappy parenting.
The good/bad thing about meds, is that stimulants are highly (80%+) effective with actual cases. The problem is that they also have benefits in sub-clinical and “normal” populations, which encourages abuse.
Notesfromthecouch

it’s nice, for once to hear EVERY facet of the adhd story….i DO believe there are people who are being wrongly medicated(like those that seek out this diagnosis strictly to obtain “drugs”) and like those that have defiance or antisocial personality disorders and are MISDIAGNOSED…however, i DO NOT agree with those that say this is a means to an end. i have been medicated…as well as my husband since WE were ten…and both he and i have (recently and more than once in the past) attempted to go without our medication and it never seems to be productive. now, most people might say that we didnt abstain from taking our meds for long enough, however both he and i have gone a year+ in a couple instances w/o taking meds and neither he nor i have anything good to say about our year(s) spent off medication.obviously, to the critics, they’d assume we just thought of the situation as bad b/c we were going thru withdrawls, however, after a year of being lost, confused, unproductive, frustrasted, and angry(b/c of lack of comprehension in a “timlely fasion”) i realized, i’m ok with saying: yeah, ok, i’m adhd, but im ALSO, a mother, a wife and a great person, oh and i take meds to help me be better at everything thats important! see, that’s okay to me…
what i’m getting at is that , if you TRULY need the meds, you KNOW it! you dont WANT it…. there’s a big difference, however, as a yale grad, i promise…a.d.h.d., is real! SO real!

People who do not have adhd should not judge what they dont understand. I have struggled my whole life not to be lazy, not to be forgetful, to sleep at night, to concentrate, to study, to pay attention, to be patient, to behave properly, not to say certain things etc. etc. etc. etc. etc. etc. you name it. Until a week ago I was exhausted, frustrated, suicidal, anxious, whatever.. no matter how hard I tried I simply could not get things straight, all my life. Im 27yrs old and learned about adhd.. I just sat there and a rush of tears just flooded as I read the symptoms.. Do you have any idea how much pain, blame, regrets and sorrow I could have avoided if I was given appropriate coaching? When I was a child, girls were never taken into consideration of being adhd positive and mine went unnoticed, until now because I was lucky and accepted something was wrong with me and pin pointed the problem myself. I cannot stop stressing the need of Adult ADHD awareness, there simply isnt enough.. Beleive it or not my coach says I am very lucky for not ending up on heavy drugs, jail or worse. On the contrary I never stopped studying (or atleast articles that held my attention) and never stopped trying to take exams. I was so determined to succeed that I managed to start a career in my chosen field even without the neccessary qualificaitons, even though I have to struggle a lot and fear my adhd symptoms might get in the way and may lose my job. Hopefully my future will be better 🙂 Please do not underestimate ADHD.. it’s pure hell..